City_of_Tampa_Subcontractors_Utilized.PDF

City of Tampa – DMI Schedule of Sub-(Contractors/Consultants/Suppliers) to be Utilized

Contract No.: __________ Contract Name: ____________________________________________ Contractor Name: _________________________________ Address ______________________________________ Federal ID __________________ Phone ____________ Fax ____________ Email __________________________ [ ] See attached documents.

[ ] No Subcontracting (of any kind) will be performed on this contract.

NIGP Code General Categories: Buildings = 909, General = 912, Heavy = 913, Trades = 914, Architects = 906, Engineers & Surveyors = 925, Supplier = 912-77

This DMI Schedule Must Be Submitted with the Bid or Proposal (Do Not Modify This Form) Enter “S” for firms Certified as Small Local Business Enterprises, “W” for firms Certified as Women/Minority Business Enterprise

S = SLBE

W=WMBE Company Name

Address Phone & Fax

Type of Ownership (F=Female M=Male) BF BM = African Am.

HF HM = Hispanic Am.

AF AM = Asian Am.

NF NM = Native Am.

CF CM = Caucasian

Trade, Services, or Materials

NIGP Code

Listed above

Amount of Quote.

Letter of Intent if available.

Percent of

Work/Contract % Federal ID

Total Subcontract/Supplier Utilization $____________________

Total SLBE Utilization $ _________________________________ Total WMBE Utilization $ ________________________________ Percent SLBE Utilization of Total Bid/Proposal Amt. _____% Percent WMBE Utilization of Total Bid/Proposal Amt. _____% Certification: It is hereby certified that the following information is a true and accurate account of utilization for sub -contracting opportunities on this contract. This form must be completed with the bid or proposal. Modifying or failing to sign DMI forms can result in Non-Compliance

Signed ________________________________ Name/Title _____________________________ Date: __________ MBD 20 rev. 03/08/12 Pg __ of __

Instructions for completing The Sub-(Contractors/Consultants/ Suppliers) to be Utilized Form (Form MBD-20)

This form must be submitted with all bids or proposals. All subcontractors projected to be utilized must be included on this form.

Contract No. This is the number assigned by the City of Tampa for the bid or proposal Contract Name. This is the name of the contract assigned by the City of Tampa for the bid or proposal.

Contractor Name. The name of your business.

Address. The physical address of your business.

Federal ID. FIN. A number assigned to your business for tax reporting purposes.

Phone. Telephone number to contact business.

Fax. Fax number for business.

Email. Provide email address for electronic correspondence.

No Subcontracting (of any kind) will be performed on this contract. Checking the box indicates your business will not use subcontractors, but will self-perform all work. If during the administration of the contract you use subcontractors, the “Sub-(Contractors/Consultants/Suppliers) Payments” form must be submitted with your invoices. Note: Certified SLBE or WMBE firms bidding as Primes are not exempt

See attached documents. Check if you have provided any additional documentation relating to the utilization of subcontractors.

from outreach and solicitation of subcontractors.

The following instructions are for information of Any and All subcontractors to be utilized.

Federal ID. FIN. A number assigned to a business for tax reporting purposes. This information is critical in proper identification of the subcontractor.

“S” = SLBE, “W” = WMBE. Enter “S” for firms Certified by the City as Small Local Business Enterprises and/or “W” for firms Certified by the City as Women/Minority Business Enterprise.

Company Name, Address, Phone & Fax. Provide company information for verification of payments.

Type of Ownership. Indicate the Ethnicity and Gender of the owner of the subcontracting business.

Trade, Services, or Materials (NIGP code if Known) Indicate the trade, service, or material provided by the subcontractor. NIGP codes are available at http:/www.tampagov.net/mbd.

Amount of Quote, Letters of Intent (required for both SLBEs and WMBEs) Percent of Work/Contract. Indicate the percent of the total contract price the subcontract(s) represent.

Total Subcontract/Supplier Utilization. – Provide total dollar amount of all subcontractors/suppliers projected to be used for the contract. (Dollar amounts do not apply to CCNA proposals.)

Total SLBE Utilization. Provide total dollar amount for all projected SLBE subcontractors/Suppliers used for this contract. (Dollar amounts do not apply to CCNA proposals.)

Total WMBE Utilization. Provide total dollar amount for all projected WMBE subcontractors/Suppliers used for this contract. (Dollar amounts do not apply to CCNA proposals.)

Percent SLBE Utilization. Total amount allocated to SLBEs divided by the total bid amount. (Dollar amounts do not apply to CCNA proposals.)

Percent WMBE Utilization. Total amount allocated to WMBEs divided by the total bid amount. (Dollar amounts do not apply to CCNA proposals.)

If any additional information is required or you have any questions, you may call the Minority Business Development Office at (813) 274-5522.